Acupressure for Infertility

Definition of Infertility:

a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.(WHO).

There are many causes of infertility, including the following:

For the male:

1. Impaired production and function of sperm, low sperm concentration. Normal sperm concentration is greater than or equal to 20 million sperm per milliliter of semen. A count of 10 million or fewer sperm per milliliter of semen indicates low sperm concentration, and the chances of conception lessen. A count of 40 million sperm or higher per milliliter of semen indicates increased fertility; also, if a sperm changes its shape and mobility or is slow, the sperm may not be able to reach or penetrate the egg.
2. The malfunction of the Hypothalamic-Pituitary-Gonadal Axis: if the axis is not working properly, the male hormone level will be disturbed and the sperm will be both low in count and slow in activity.
3. The testes system, including transportation and maturation.

For the female:

1. Fallopian tube damage or blockage.
2. Endometriosis.
3. Ovulation disorders.
4. Hormonal causes, such as hypothyroidism,
4. Early menopause.
5. Polycystic ovary syndrome.
6. Fibroid in the uterine.
Even though there are many women who cannot conceive because of the above reasons, there are also 15-20 % of couples who cannot conceive due to unexplained reasons, and Amy falls into this category. Therefore, many couples have to use the following technology for help.

Assistant Reproductive Technology:

1.     Intrauterine Insemination (IUI)

Intrauterine insemination is the placement of a man’s sperm into a woman’s uterus using a long, narrow tube, which usually help the sperm to go upstream to meet eggs. The successful rate sometimes can be 20%.

2.     In Vitro Fertilization (IVF)

Eggs and sperm are taken from the couple and are incubated together in a dish in a laboratory to produce an embryo. The embryo then will be placed into the woman’s uterus, where it may implant and result in a successful pregnancy.

A. IVF stimulation protocols in the US generally involve the use of 3 types of drugs:

1), Medications to suppress the luteinizing hormone (LH) surge and ovulation until the developing eggs are ready.

There are 2 classes of drug used for this:
GnRH-agonist (gonadotropin releasing hormone agonist) such as Lupron,
GnRH-antagonist such as Ganirelix or Cetrotide
Lupron essentially “shuts down” the body’s reproductive hormone system.
While shut down, IVF patients use a follicle stimulating hormone (FSH) drug like Gonal-F or Follistim, to cause the recruitment and development of follicles. Dosages of FSH are adjusted based upon each patient’s response and it is continued until the follicles are mature.

2), FSH product (follicle stimulating hormone) to stimulate development of multiple eggs

Gonal-F, Follistim, Bravelle, Menopur

3), HCG (human chorionic gonadotropin) to cause final maturation of the eggs

The ovaries are stimulated with the injectable FSH medications for about 7-12 days until multiple mature size follicles have developed.
Ovulation cannot occur naturally while on Lupron because LH, which triggers ovulation, is suppressed. This prevents a premature surge of the LH before the retrieval, which could cause loss of the cycle. Once the eggs are mature, an injection of Human chorionic gonadotropin (hCG) or LH is given to stimulate ovulation. Egg retrieval is scheduled 35 hours later.

 B. Egg Retrieval:

this is the process used to remove the eggs from the ovaries   so they can be fertilized.

C. Fertilization:

the sperms are placed in a dish with the egg and left overnight in an incubator. Fertilization usually occurs on its own. However, sometimes, a single sperm is injected into an egg using a needle. This process is called intracytoplasmic  sperm injection (ICSI). About 60% of IVF in the Unites States is performed with ICSI.Embryos that develop from IVF are placed into the uterus from 1 to 6 days after retrieval.

 D. Embryo Transfer:

a long, thin tube will be inserted through the vagina and into the uterus and injects the embryo into the uterus. The embryo should implant into the lining of the uterus 6 to 10 days after retrieval.

Evidence of Acupuncture as an adjunct to IVF

Now, more and more evidence show acupuncture as an excellent adjunct to IVF. In one article published in Evidence Based Complement Alternative Medicine, 2012, Zheng, et al found out that Twenty-three trials ( a total of 5598 participants)  indicate that acupuncture, especially around the time of the controlled ovarian hyperstimulation, improves pregnancy outcomes in women undergoing IVF.
(Evid Based Complement Alternat Med. 2012;2012:543924. doi: 10.1155/2012/543924. Epub 2012 Jul 2.
The role of acupuncture in assisted reproductive technology.
Zheng CH1, Zhang MM, Huang GY, Wang W.)

Another study also showed significant improvement of odds with acupuncture treatment.
Reprod Biomed Online. 2015 Jun;30(6):602-12. doi: 10.1016/j.rbmo.2015.02.005. Epub 2015 Feb 24.
Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes.
Hullender Rubin LE1, Opsahl MS2, Wiemer KE2, Mist SD3, Caughey AB3.

The following acupuncture protocols are used to help IVF patients:

A.    Lupron Routine:

to help suppress the luteinizing hormone (LH), and reduce the side effects of Lupron, Ganirelix or Cetrotide

1.     Diji (SP8), Zhongji (Ren 3), Xuehai (SP6), Zusanli (St 36), Sanyinjiao (SP6), Hegu (LI4), Taicong (Lv3).
2.     Cerebrum acupoints（HP-Zone）
Yameng(DU15）， Fengfu（DU16），Naohu（DU17）
Tianzhu（UB10），Fengchi（GB20），Wangu（GB12）
3.     Huatuojiaji:

B.    FSH Routine:

to help stimulation of multiple eggs.

1.     Cerebrum acupoints（HP-Zone）

Yameng(DU15）， Fengfu（DU16），Naohu（DU17）
Tianzhu（UB10），Fengchi（GB20），Wangu（GB12）

2.     Intersection-Zone:

Baihui（Du20），Sishencong（EX-HN-1），Touwei（St8）

3.     Abdominal Zone:

Guanyuan (Ren 4),Zigong (EX Points)

4.     Sacrum-Zone:

Mingmen (DU4)，Shenshu (UB23), Eight Liao Points (UB31-UB34).

C.    HCG Routine:

to improve the final maturation of the eggs
1.     One day before egg retrieval: Neiguan (PC6) , Zusanli(St36), Pishu (UB20), Shenshu (UB23), Ganshu(UB18) , Diji (SP8), Taixi (Kid3), Taicong (Liv 3), Quchi (LI11).
2.     Three hours before egg retrieval: Zigong (Extra Points), Sanyinjiao (SP6), Hegu(LI 4), Neiguan(PC6), Taicong(Liv 3), Quchi(LI11).

D.    After Egg Retrieval:

Many patients showed the following symptoms, such as abdominal tender, emotional unsteady, headache, weight gain, nausea and sometimes vomiting, etc.
On the same day: Qihai (Ren 6), Shuidao (St 28), Daimai(GB26), Yinlingquan(Sp9), Sanyinjiao(SP6), Zusanli(St36), Xiaguan (St7), Quchi(LI11), Taicong(Liv3).

E.    For the mobility and viability of Sperm:

Zhongji(Ren3), Guanyuan(Ren4), Zusanli(St36), Taixi(Kid3), Shenshu(UB23), Mingmen(Du 4), Dahe(Kid12), Sanyinjiao(SP6).

F.    Before the Embryo Transfer:

For continues three days: Qihai(Ren6), Guanyuan(Ren7), Sanyinjiao(SP6), Zusanli(St36), Taixi(Kid3), Xuehai(Sp10), Pishu(UB20), Shenshu(UB23), and Ganshu(UB18).

G.   After the Embryo Transfer:

Within 24 hours: Quchi(LI11), Neiguan(PC6), Sanyinjiao(SP6), Zusanli(St36), Taicong(Liv3).
Within 36 hours: Quchi(LI11), Zusanli(St36), Xuehai(Sp10), Diji(Sp8), Taixi(Kid3), Taicong(Liv3), Ear Shenmen, Ear Neifenmi, Ear Zigong.

H.    After confirmed pregnancy:

Quchi(LI11), Zusanli(St36), Neiguan(PC6), Yinlingquan(Sp9), Taixi(Kid3), Taicong(Liv3), Ear Shenmen, Ear Neifenmi, Ear Stomach, until six weeks of pregnancy.

Some important acupuncture points:

Amy’s treatment:

Amy was scheduled to have hormone regulation (hormone treatment) for a month before trying to become pregnant again, and to have acupuncture treatments with me three times a week during that month.

After four weeks of treatment, Amy underwent the IVF procedure and was kept on the acupuncture treatment twice a week. Amy reported to me that she had eight eggs mature, a much improvement compared with  the first IVF treatment which had produced only three mature eggs.
After a 48 to 72 hour culture, six of her eggs were fertilized and Amy’s doctor implanted four into the uterus. The doctor told her she should have bed rest overnight and that she could return to work the next day; however, I told her to have bed rest for two days, because Amy’s job is more stressful than most people’s, and she has to bend forward in her work to deliver babies.
A month after insemination Amy told me she was pregnant. She was very excited about her condition and eight months later delivered twins, a boy and a girl. She was thrilled with the results, as was her husband.